High Tibial Osteotomy Is NOT Indicated for These Alignment Parameters
Your LDFA and MPTA values fall within normal ranges and do not meet criteria for high tibial osteotomy. HTO is reserved for patients with pathological varus malalignment causing symptomatic unicompartmental osteoarthritis, not for normal or near-normal alignment angles 1, 2.
Understanding Your Alignment Values
Your measurements indicate essentially normal lower limb alignment:
- LDFA (Lateral Distal Femoral Angle): Your values of 87-89° are within the normal range of 85-90° 3
- MPTA (Medial Proximal Tibial Angle): Your values of 83-84° are within the normal range of 85-90°, though slightly on the lower end 3
These angles do not represent the pathological varus deformity that HTO is designed to correct 4, 5.
When HTO Is Actually Indicated
HTO is appropriate only when ALL of the following criteria are met 1, 2, 6:
- Symptomatic medial compartment osteoarthritis with persistent pain despite conservative management 1, 5
- Pathological varus malalignment typically with hip-knee-ankle angle showing >5° of varus deformity 1
- Active patients who wish to delay or avoid total knee replacement 1, 2
- Age typically <60-65 years with reasonable activity demands 6, 5
- Intact lateral compartment without significant arthritis 5, 7
The goal of HTO is to correct pathological varus to 3-8° of valgus (approximately 170° femoro-tibial angle), shifting load from the diseased medial compartment to the healthier lateral compartment 4, 6.
Why Your Case Does Not Qualify
Your alignment parameters suggest you do not have the pathological deformity that HTO addresses 2, 5:
- Normal LDFA indicates no significant femoral contribution to varus deformity 3
- Near-normal MPTA indicates no significant tibial metaphyseal deformity requiring correction 3
- Without documented symptomatic unicompartmental osteoarthritis and pathological malalignment, HTO would be inappropriate and potentially harmful 1, 2
Regarding Bone Graft
Bone graft in HTO is used specifically for opening-wedge techniques to fill the created gap 6, 7:
- Autograft, allograft, or bone substitutes are used to support the correction and promote healing 6
- This is only relevant when performing the actual osteotomy procedure 7
- Since HTO itself is not indicated in your case, the question of bone grafting is moot 6
Critical Pitfall to Avoid
Performing HTO on normally aligned knees can create iatrogenic valgus deformity, leading to lateral compartment overload, pain, and accelerated lateral compartment arthritis 4, 3. The procedure should never be performed without documented pathological varus malalignment and symptomatic medial compartment disease 1, 2, 5.
What You Should Actually Consider
If you have knee symptoms, appropriate evaluation should include 1:
- Standing full-length hip-to-ankle radiographs to measure actual mechanical axis and hip-knee-ankle angle 1
- Assessment for presence and location of osteoarthritis 1
- Evaluation of ligamentous stability and meniscal integrity 5, 7
- Trial of conservative management including physical therapy, weight optimization, and anti-inflammatory measures if osteoarthritis is present 1